Aetna Medicare Enhanced (PPO) Medicare Advantage Plan H1608-013 • 2026 • Pike County, MO

Aetna Medicare Enhanced Overview

Coverage Overview for Aetna Medicare Enhanced

This MAPD PPO Medicare Advantage plan includes Medicare Part A and Part B services along with integrated prescription drug coverage. The monthly premium is $60.00, and the plan allows access to Medicare-approved providers, with lower costs when using in-network providers. The annual Part D deductible is $615.00.

Primary care visits have a $0 copay | Out-of-network: 45% coinsurance, and specialist visits come with a $0-$45 copay | Out-of-network: 45% coinsurance. Urgent care services carry a $40 copay, and ground ambulance transportation is $300 copay | Out-of-network: $300 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $7500.00. After this limit is reached, in-network services are fully covered.

This plan is recognized by CMS under Plan ID H1608-013. Cost-sharing details are outlined below.

Cost Sharing Expenses

Cost-sharing for Aetna Medicare Enhanced includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H1608-013.

Certain preventive services are covered 100% by Aetna Medicare Enhanced as a Part B benefit.

Prescription Drug Coverage

Aetna Medicare Enhanced includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Aetna Medicare starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Aetna Medicare Enhanced may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS 5-Star Ratings

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.